April 2009 - Non-Communicable Diseases


HLT/059 - April 2009




Public Health 123 (4); April 2009

Fantahun, M. et al. Ageing of a rural Ethiopian population: who are the survivors? Pp. 326-330

This study assessed trends in survival to old age and identified the factors associated with longevity among the elderly (age ≥65 years).The study was conducted in the Butajira Rural Health Programme Demographic Surveillance Site in Ethiopia. Using data collected between 1987 and 2004, the probability of survival to 65 years and remaining life expectancy for women and men aged 65 years were computed. Cox regression analysis was used to assess survival by different factors. Although the elderly represented 3% of the population, their person-time contribution increased by 48% over the 18-year period. Less than half reached 65 years of age, with remaining life expectancy at 65 years ranging from 15 years in rural men to 19 years in urban women. Rural residence, illiteracy and widowhood were associated with lower survival adjusted for other factors, whereas gender did not show a significant difference. However, the effect of these factors differed between men and women, as demonstrated by survival curves and Cox regression. Widowhood [hazard ratio (HR) 2.02, 95% confidence interval (CI) 1.59–2.57] and illiteracy (HR 2.26, 95% CI 1.86–2.73) affected males to a greater extent than females, and rural residence was associated with poorer female survival (HR 1.68, 95% CI 1.55–1.83).The number of elderly people is increasing in Ethiopia, with the chance of survival into older age being similar between men and women and approaching that in developed countries. However, rural women and illiterate women and men, particularly widowers, are disadvantaged in terms of survival… http://www.elsevier.com/locate/puhe



BMC International Health and Human Rights 9(5); March 2009

Ssebunnya, J. et al. Stakeholder perceptions of mental health stigma and poverty in Uganda

World wide, there is plentiful evidence regarding the role of stigma in mental illness, as well as the association between poverty and mental illness. The experiences of stigma catalyzed by poverty revolve around experiences of devaluation, exclusion, and disadvantage. Although the relationship between poverty, stigma and mental illness has been documented in high income countries, little has been written on this relationship in low and middle income countries. The paper describes the opinions of a range of mental health stakeholders regarding poverty, stigma, mental illness and their relationship in the Ugandan context, as part of a wider study, aimed at exploring policy interventions required to address the vicious cycle of mental ill-health and poverty.Semi-structured interviews and focus group discussions (FGDs) were conducted with purposefully selected mental health stakeholders from various sectors. The interviews and FGDs were audio-recorded, and transcriptions were coded on the basis of a pre-determined coding frame. Thematic analysis of the data was conducted using NVivo7, adopting a framework analysis approach.According to a range of mental health stakeholders in Uganda, there is a strong interrelationship between poverty, stigma and mental illness. These findings re-affirm the need to recognize material resources as a central element in the fight against stigma of mental illness, and the importance of stigma reduction programmes in protecting the mentally ill from social isolation, particularly in conditions of poverty...



BMC Public Health 9(103); April 2009

Wouters, E. et al.  Physical and emotional health outcomes after 12 months of public-sector ART in the Free State Province of South Africa: a longitudinal study using structural equation modelling

African and Asian cohort studies have demonstrated the clinical efficacy of antiretroviral treatment (ART) in resource-limited settings. However, reports on the long-term changes in the physical and emotional quality of life (QoL) of patients on ART in these settings are still scarce. This study aims to assess the physical and emotional QoL after 6 and 12 months of ART in a sample of 268 patients enrolled in South Africa's public-sector ART programme. The study furthermore tested the impact of the adverse effects of medication on patients' physical and emotional QoL.A stratified random sample of 268 patients undergoing ART was interviewed at baseline (6 months ART) and follow-up (12 months ART). A model of the relationships between the duration of ART, the adverse effects of medication, and physical and emotional QoL (measured using EUROQOL-5D) was tested using structural equation modelling.This study provides evidence that the South African public-sector ART programme is effective in delivering sustained improvements in patient well-being. However, the results urge clinicians and lay health workers to be vigilant regarding the adverse effects of treatment, because they can seriously affect physical and emotional QoL…



International Journal of Mental Health Systems 3(7); April 2009

Hustache, S.et al. Evaluation of psychological support for victims of sexual violence in a conflict setting: results from Brazzaville, Congo

Little is known about the impact of psychological support in war and transcultural contexts and in particular, whether there are lasting benefits. Here, we present an evaluation of the late effect of post-rape psychological support provided to women in Brazzaville, Republic of Congo. Women who attended the Médecins Sans Frontières program for sexual violence in Brazzaville during the conflict were selected to evaluate the psychological consequences of rape and the late effect of post-rape psychological support. A total of 178 patients met the eligibility criteria: 1) Women aged more than 15 years; 2) raped by unknown person(s) wearing military clothes; 3) admitted to the program between the 1/1/2002 and the 30/4/2003; and 4) living in Brazzaville. We found the benefits of post-rape psychological support to be present and lasting in this conflict situation. However, we were unable to evaluate all women for the long-term impact, underscoring the difficulty of leading evaluation studies in unstable contexts. Future research is needed to validate these findings in other settings… http://www.ijmhs.com/content/pdf/1752-4458-3-7.pdf



Food Policy 34(2); April 2009

Muller, C. Do agricultural outputs of partly autarkic peasants affect their health and nutrition? Evidence from Rwanda Pp. 166-175

In rural areas of less developed countries because of market imperfections, the health and nutritional status of peasants may directly depend on the production levels of specific agricultural goods rather than solely on income levels. This channel of health and nutrition determination has never been studied. In order to assess and test the empirical possibility of this channel, we estimate the responses of health and nutritional status of autarkic agricultural households in Rwanda with respect to differences in socio-demographic characteristics and the main agricultural outputs and inputs while controlling for local environment and sampling scheme. Several food outputs are found to have a positive influence on health and nutrition, whereas the production of traditional beers has a negative impact. Moreover, greater land negatively affects health and nutrition, conditionally on agricultural production, perhaps because of a larger relative workload for households who have a large farm. An alternative interpretation of the estimates is that they inform on the validity of the common hypothesis of perfect agricultural input/output markets with no effect of agricultural inputs/outputs on health and nutrition status. This hypothesis is rejected... http://www.elsevier.com/wps/find/journaldescription.cws_home/30419/description#description

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Relatório Bienal do Director Regional
[pdf 3.3Mb]